THE DEA'S WAR ON PAIN DOCTORS

Twenty-four years after Darlene broke her back in a swimming pool accident,
crippling pain still rules every aspect of her life, from getting up in the
morning (which she describes as akin to "climbing the highest mountain") to
falling into a fitful sleep at night. After years of botched surgery that
left her in even more agony, she knows there is no real cure for what ails
her, but thanks to synthetic opioids (which include such regulated
substances as Vicodin, Dilaudid, and the devil drug of the moment,
OxyContin), she says that she can now lead a halfway normal life. Just
folding sheets or washing dishes or sitting at the computer are daily
miracles for Darlene, who claims she would otherwise be bedridden and
suicidal without the chemical crutches that high doses of these powerful
opium-like painkillers provide.

But in some ways worse than the pain, says Darlene (who doesn't want her
last name revealed), are the shame and fear that come with it. Shame when
she goes to have her special triplicate prescription--required for all
scheduled drugs--filled at the drugstore and the pharmacist looks at her as
if she were some addict abusing the drug to get high. Fear that her
medications will soon be taken away by the Drug Enforcement
Administration's ongoing crackdown on pain doctors. "You worry every day
that the medicine won't be available for much longer, or your doctor won't
be there tomorrow because he's been arrested by the DEA," she claims.

All the bad publicity in the press about the abuse of OxyContin by
celebrities such as Rush Limbaugh and Courtney Love doesn't help matters.

But, says Darlene, the media scare stories shouldn't blind people to the
fact that these drugs--when taken under medical supervision--have made life
livable for hundreds of thousands of chronic pain patients, herself included.

Some in the medical community call it "a war on pain doctors," others "a
government jihad" or "state-sponsored terrorism." However you describe the
current campaign, which according to pain-patient advocates began under
Janet Reno, but which they say has increased in intensity under John
Ashcroft, the DEA's hardball tactics--storming clinics in SWAT-style gear,
ransacking offices, and hauling off doctors in handcuffs--have scared
physicians nationwide to the extent that legitimate pain sufferers now find
it increasingly difficult to get the medicine they need. Doctors' offices
today display signs that say "Don't ask for OxyContin" or "No OxyContin
prescribed here." And medical schools advise students not to choose pain
management as a career because the field is too fraught with potential
legal dangers.

"The war on drugs has turned into a war on doctors and pain patients," says
Dr. Ronald Myers, president of the American Pain Institute and a Baptist
minister who operates a string of clinics for poor people in the
Mississippi Delta. "Such is the climate of fear across the medical
community that for every doctor who has his license yanked by the DEA,
there are a hundred doctors scared to prescribe proper pain medication for
fear of going to prison.

The DEA is creating a situation where legitimate pain patients now have to
go to the streets to get their medication. It's a health care catastrophe
in the making." (Myers theorizes that Rush Limbaugh is probably "a
neglected pain patient" and another victim of the crackdown: "Why else
would someone with all his money have to go to the street to get enough
medication, other than if he couldn't find a doctor to give him an adequate
supply?")

Advocates for pain doctors and their patients have had enough. Limbaugh's
recent admission that he's addicted to OxyContin and other painkillers has
brought the issue of pain management and the law to the fore in the media.
But the September arrest of northern Virginia's Dr. William Hurwitz--a
respected if controversial pioneer in high-dosage pain
treatment--galvanized opposition among physicians and patients to the DEA's
harsh approach.

Hurwitz, a leading specialist in his field, was arrested on federal
drug-trafficking charges, accused of prescribing excessive quantities of
OxyContin to addicts who he knew were selling the drugs on the street.

The 49-count indictment alleges that his prescribing practices led to the
death of three patients and bodily harm to two others.

Federal prosecutors have depicted Hurwitz, a contentious figure who has had
his license suspended three times by medical boards, as no better than "a
street-corner crack dealer . . . who dispensed misery and death." After
initially being threatened with the death penalty, Hurwitz now faces life
in prison.

But others defend the doctor. "Dr. Hurwitz saved my husband's life," says
Siobhan Reynolds, founder of the Pain Relief Network, a New York City-based
grassroots organization defending pain doctors and their patients. For over
a decade, Reynolds's husband has suffered terrible head pain caused by a
connective-tissue disorder. "Other doctors treated my husband like a leper.
If it weren't for Dr. Hurwitz, he would have killed himself. Dr. Hurwitz is responsible for every day that my son has a father."

After the arrest, the Association of American Physicians and Surgeons
condemned the prosecution at a news conference held at the National Press
Club in Washington, D.C., saying that doctors who treat pain patients are
heroes, not felons.

A major protest on the National Mall is being organized by the National
Pain Patients Coalition for next April to bring attention to what some
experts regard as the No. 1 health issue in America: the under-treatment of
chronic pain. And a push is on in various states to get politicians to pass
bills guaranteeing patients' right to opioids to alleviate their suffering,
if a doctor deems it necessary.

Many doctors used to think that extreme pain was something that their
patients just had to live with. The pain-management movement that has
sprung up over the past few years takes a radically different tack,
believing that long-term chronic pain can be managed with large amounts of
synthetic opium, a treatment that remains controversial both within and
outside the medical community.

The extremely high doses often prescribed--sometimes dozens of pills a
day--can seem dangerous and excessive to both laymen and other physicians.
A number of doctors insist that these drugs are so powerful that no one
should be prescribed them except end-stage cancer patients.

But pain-management advocates argue that despite the scare stories, drugs
such as OxyContin are actually safer than the alternatives and are much
more effective.

The DEA denies there's been an increase in investigations and prosecutions
of physicians and refutes the notion that it's engaged in a crackdown on
pain doctors in general.

The agency insists that it's after only rogue practitioners who
overprescribe the medicines and who know--or should know--that their
patients are selling the drugs on the black market.

So far this year, says the DEA, the agency has launched 557 investigations,
pursued actions against 441 doctors, and arrested 34, a small fraction of
the nearly 1 million physicians licensed to dispense controlled drugs. "DEA
statistics," the agency proclaimed on October 30, "show that the vast
majority of practitioners registered with the DEA comply with the
requirements of the Controlled Substances Act and prescribe controlled
substances in a responsible manner." The agency added, "Doctors operating
within the bounds of accepted medical practice have nothing to fear from
the DEA."

But some doctors believe that the DEA, having conspicuously failed to stem
the tide of illegal drug use in this country, is coming after physicians to
ratchet up the agency's prosecution count. (This year alone, two federal
reviews lambasted the DEA for its poor performance in fighting illegal drug
use, one report giving the agency a zero on a scale of one to 100.)

"They're unable to take down the real drug lords, so they're coming after
doctors using the same tactics," one pain physician tells the Voice. For an
agency keen to justify its massive budget, doctors provide an easy target.
Consider some other recent cases:

In Roanoke, Virginia, pain specialist Dr. Cecil Knox and two of his
associates were accused of operating what federal prosecutors call "a pill
mill." Prosecutors alleged that Knox overprescribed OxyContin and methadone
to increase the profits of his financially struggling operation and that
this contributed to the deaths of eight patients.

Armed agents in flak jackets raided Knox's office. "They all came in with
guns drawn," a clinic employee who was present during the raid reported to
the Pain Relief Network. "I thought I was going to die. My husband was
helping out that day, and a DEA agent came in and pointed a gun at his head
and said, 'Get off the phone now.' " (As this story went to press, news
came that the feds failed to win a single conviction in the case; the jury
cleared Knox of 30 of the 69 charges, deadlocking on the remaining counts.)
In another case of DEA strong-arm tactics, more than 20 agents burst into a
Dallas pain clinic in June. The agents kicked down doors, ransacked the
office of Dr. Daniel Maynard, and handcuffed patients, including an elderly
woman with a stroller and an oxygen tank.

In South Carolina, physician Deborah Bordeaux was convicted earlier this
year under a federal drug-kingpin statute and is currently awaiting
sentencing. She faces up to 100 years in prison as a major drug dealer for
dispensing opiates to patients suffering from chronic pain at a Myrtle
Beach clinic, where she had worked for only two months.

Dr. Benjamin Moore, who worked at the same clinic, committed suicide in
July 2002 rather than testify against his co-workers.

In Arkansas, Dr. Randeep Mann claims that a patient approached him in 2002
and told him that a federal agent had offered her $250 to say that Mann had
prescribed her painkillers in exchange for sex. Mann also charges that
another female patient told him that local authorities had offered to
forgive her cocaine arrest if she told the same lie in court. "They
destroyed my practice and they've managed to run away a lot of my patients,
and I can no longer prescribe opioids, but I still have my license," Mann
tells the Voice.

In New Orleans, Dr. David Jarrott, who specializes in pain management,
claims that an undercover DEA agent posing as a truck driver tried to
entrap him by giving him fake X-rays to secure a supply of Vicodin for a
supposed bad back. Jarrott also says the same agent tried to bribe him for
amphetamine-based diet pills claiming he needed to stay awake while driving
his truck. In early October, the doctor had his license suspended for three
years after two of his patients died, one of whom, unbeknownst to Jarrott,
was mixing street drugs with his legitimate medication.

In Arizona, Dr. Jeri Hassman, who runs Tucson's biggest pain practice, was
indicted in March after a sting involving two undercover agents and a
three-time-convicted felon.

She is being threatened with a 28-year prison term because some of her
patients abused prescriptions she wrote.

It's not just on the federal level that harsh punishment is being meted
out. Dr. Robert Weitzel from Utah was convicted of negligent homicide and
sentenced to 15 years in prison.

He gave morphine to a 91-year-old patient, who soon after died of heart
disease. Weitzel won a retrial (and acquittal) in November 2002 after it
was learned that a local prosecutor had concealed exculpatory evidence.

In Florida in the same year, Dr. James Graves was not so lucky, becoming
the first U.S. physician to be convicted of manslaughter related to an
OxyContin prescription, after local authorities charged that four of his
patients fatally overdosed on OxyContin, some of them after combining it
with illegal street drugs. Graves contended that his patients would not
have died if they had taken the drugs as directed.

He is currently serving 63 years.

Federal officials claim that nearly 500 people died from overdosing on
OxyContin in 2002, but a recent article in The Journal of Analytical
Toxicology could find only 12 cases in which OxyContin was the sole cause
of death; all the others fell victim to poly-drug abuse--mixing OxyContin
with cocaine, alcohol, Valium, or various other substances.

"Opioids when taken under clinical supervision are not that dangerous,"
says the American Pain Institute's Myers. "The data tells us that only 3
percent of people who take opioids become addicts.
The latest research conclusively shows that the best medicines for the
treatment of chronic pain are narcotics.
They have less side effects and more benefits than any other type of drug."

More dangerous, contends Myers, are the everyday drugs that pain sufferers
turn to when they can't get narcotics. He talks about something called
"suicide by Tylenol": "When chronic pain patients can't get opioids, they
go out and use tremendous amounts of drugs like Tylenol and Motrin, which
can cause serious liver and kidney damage.
Pain patients are dying from kidney and liver disease because of this."

Many pain patients are also dying by their own hand, according to the Pain
Relief Network's Reynolds. "All over America, pain patients are committing
suicide because of the DEA's campaign," she claims. "I know of at least 17
recent cases in Arkansas alone.

It's really astonishing the amount of human carnage that this campaign has
already caused."

Fumes Myers: "What's going on here is morally reprehensible and medically
incomprehensible and it has to stop. Doctors who treat pain patients are
not criminals."